Poorer people passing up cancer screenings

August 24th, 2012 by Philip Brasor & Masako Tsubuku

As long ago as the early 1980s the health ministry made it a priority to get more people to undergo cancer screenings in order to detect the disease at its earliest and easiest-to-treat stages. By 2009, the goal was to have 50 percent of the targeted adult population receive annual tests for five types of cancer — colon, stomach, breast, uterus, lung — by 2012. That goal was not reached, so they moved it back another five years, but since the overall screening rate at present is still somewhere between 20 and 30 percent, it doesn’t appear the ministry is going to achieve that goal either.

Cancer screening menu

I’ll take one from column A, and…: Cancer screening menu distributed by local government (click to enlarge).

According to an article in Asahi Shimbun, the main obstacle is income. A center for adult diseases in Osaka analyzed surveys carried out by the health ministry and found that the higher a person’s income is, the more likely he or she is to undergo cancer screenings. In fact, screening rates have a direct correlation to the public health insurance program a person is enrolled in. For instance, 48 percent of males enrolled in the Kyosai Kumiai insurance program receive colon cancer screenings. The rate drops to 38 percent for a man in the Kumiai Kenpo program, 27 percent for one in the Kyokai Kenpo program, 19 percent for those who use regular kokumin hoken (national insurance), and only 13 percent for people on public assistance, who get their insurance free.

Kyosai Kumiai members are national and local civil servants, including public school teachers, whose average income in 2009 was ¥2.36 million. Kumiai Kenpo is insurance for companies with 100 or more companies, of which the average member makes ¥1.95 million. Kyokai Kenpo is for companies with less than 100 employees. Their average salary is ¥1.39 million. Regular kokumin hoken is for part-timers, pensioners and the self-employed, who average ¥910,000 a year. People on welfare, of course, don’t have income.

Cancer checks are managed by local governments, who set up screenings at public facilities or cooperating hospitals and clinics, usually for limited periods at specific times of the year. The Osaka center found that part-timers, the self-employed and workers at smaller companies usually cannot take time off whenever they want to, and thus are less likely to be able to go to the facility when the screenings are being conducted, usually on weekdays. Moreover, they may not have the money to pay the nominal fees for the screenings, which can cost anywhere from a few hundred yen to ¥2,000 or more. Even though welfare recipients get free insurance, they have to pay these fees as well. And there’s a fee for each screening, so if you are a woman and undergo all five of the tests recommended it could cost as much as ¥10,000. And there are lots of tests for other types of cancer, each of which requires a fee.

The Asahi says that the health ministry every year increases its budget for the cancer screening program in order to meet its goals, but apparently no special attention is being paid to this income gap, meaning all income brackets are being targeted equally through promotional efforts. Many local governments, for instance, issue “coupons” for discounts on certain screenings during certain periods — think of it as a limited-time bargain sale for barium cocktails — but the coupons are given to everyone, regardless of income or insurance plan. This sounds like fairness, but it could also be considered a waste of resources. The Health Ministry doubled its budget for cancer screening promotion from ¥64 billion in 2008 to ¥130 billion in 2009, and it’s been going up ever since. If it wanted to use that money more effectively towards its stated aim, it should allocate funds where they would be most effective by thinking of ways to get more lower-income people to screening programs.

Then again, there are some who don’t believe that cancer screenings are effective and that the whole program is a racket. In any case, it is the only health check system promoted by the government at such a level. National health insurance doesn’t cover general health checkups, though some local governments may. If you want one of those and you don’t belong to a company or organization that provides them, then you have to pay full price; or go to the hospital with an unknown illness and just let them examine you for everything until they’ve exhausted the full battery of tests — something we’ve actually done. After all, people die of things other than cancer.

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